The idea of a safe injection site for Chilliwack is gaining support.
Two front-line physicians in Chilliwack are touting the benefits of this approach for treating opiate addiction.
The community conversation about the opioid crisis is underway in Chilliwack against a backdrop of exploding homeless numbers, petty crime and used needles in the streets.
Emergency room physician Dr. Marc Greidanus has first-hand experience with the impacts.
"I see it in Emergency," he told The Progress. "It's obstructing everyone's care when staff are busy dealing with overdoses."
Mitigating with the health effects of homelessness, addictions, crime and mental health issues can eat up a good portion of his workday in the ER.
A safely monitored site for Chilliwack's addicts would reduce the chaos significantly, he suggests.
"A supervised injection facility, offering counselling and prescription heroin or hydromorphone, removes the motivation for petty theft, reduces chaos in the life of an addict, improves adherence to social housing strategies, frees up ambulances for other urgent calls — and saves lives," said the ER doctor.
The scientific evidence is in, and the studies are very promising.
"It makes sense," notes Dr. Greidanus, "addicts don't want to steal bikes and cell phones to pay for their next fix."
It is moving forward elsewhere in the region. Fraser Health announced two "safe consumption" sites being proposed for Surrey, since that's where most of the region's overdose fatalities occurred.
But there are no such efforts in sight for Chilliwack — yet.
A whopping 259 people died of illicit drug overdoses in the Fraser region, from Burnaby to Boston Bar, in the past year alone, and property crime rates skyrocketed in most communities.
It helps that there is "unequivocal medical consensus" that harm reduction works.
"It is a moral, health and fiscal imperative that our municipal, provincial and federal politicians work together with Fraser Health and our local physicians to produce an evidence-based Chilliwack response to a growing problem," Dr. Greidanus said.
"A safe injection site benefits us all."
Similar results are coming out of Holland and Germany, as well as in pilot studies out of St. Paul's Hospital in Vancouver.
"It may seem counterintuitive to pay for drugs for addicts, but it's been shown to also save on medical, court and policing costs," he said.
Politicians at all levels are starting to weigh in on the idea of supervised injection sites to address the worst aspects of the fentanyl crisis across B.C.
Coun. Ken Popove, co-chair of the Chilliwack Healthier Community, recently stated he could see the advantage of supervised injection services for Chilliwack as long as there was counselling and wraparound services also available.
It has not yet been discussed by city council as a whole, said Mayor Sharon Gaetz, because establishing such sites would technically be a provincial health matter.
"If a safe injection site were to come to Chilliwack, the city’s role would be to ensure the location is properly zoned. In such an instance, the matter would come to a public hearing."
The mayor sees the value of expanded detox services.
"Our community has consistently advocated for increased services for those addicted to drugs. We have long held the position that our city is in dire need of expanded detox services and believe this should be the first priority of the Province and Fraser Health.
"This will not only assist those who wish to get off of drugs but will result in a reduction of crime that is connected to drug use."
According to Fraser Health protocol at this point, the most effective treatment in general is seen as "opioid substitution" which means prescribing medications such as suboxone and methadone for heroin addiction, and other opioid use disorders.
Opioid substitution is considered effective in reducing the use of opioids, improving physical health and reducing death rates.
"We’re doubling capacity for opioid substitution treatment at our two sites in Surrey, and we’re enhancing these services in Abbotsford and Maple Ridge," said Michael Marchbank, president and CEO of Fraser Health.
"Over the past 18 months, we’ve opened dozens of substance use treatment beds in our region, and we’re on track to open another 100 beds in 2017."
But while supervised injection or safe consumption sites are something to "keep in mind" right now the emphasis is still firmly on substituting heroin with prescription methadone or suboxone.
"Currently we have a opiate substitution clinic in Chilliwack that works fairly well," said Dr. Chantal Chris, referring to the Cedarview Clinic which offers a methadone maintenance program in Chilliwack on College Avenue.
Although her main job is as a palliative care physician, Dr. Chris is also the physician member of the Chilliwack Outreach Team, working the homeless and addicted at the street level. She also sees patients at the primary care clinic inside Chilliwack General, where many struggle with chronic pain and addictions.
Methadone is known for at staving off withdrawal symptoms from street drugs, and forms part of the traditional treatment approach.
There is a sizable component of the population that is simply not ready to go to a clinic for methadone, Dr. Chris pointed out, even though they put their lives on the line every time they shoot drugs.
Some are not ready, or have contraindications to methadone.
"They could be in denial or at a different stage of their illness," said Dr. Chris. "So there is a large segment of the population who are very sick with their addictions, and these are the people for whom we are not able to help decrease mortalities, or stop the overdoses."
They will inject heroin-laced with fentanyl or even worse, carfentanyl and it's not entirely their fault, she said. The very crux of the illness is that they need the drug more and more.
"So for those people, we don't have anything other than needle exchange, and outreach services, and Naloxone for overdoses, which is a reactive type of harm reduction," said Dr. Chris. "That population is one where a safe consumption site would be helpful."
It's not about health officials watching people shoot heroin, but actually connecting them with multi-disciplinary health care and social services.
"It allows them to use safely, and decreases mortalities. It allows us to get our foot in the door, to introduce ourselves and establish long-term relationships to help them get better."
Some patients who've discussed the idea with Dr. Chris would definitely be in favour of safe injection sites.
"Most who are using know that it's unsafe," she said. "They're scared on a daily basis. They don't want to continue it's just really difficult to stop. I think they would appreciate the help."